Hypodermoclysis

1. See Also
   1. Hypodermoclysis Technique
2. Definition
   1. Subcutaneous fluid administration
3. Indications
   1. Mild to moderate dehydration in adults
      1. Geriatric patients
      2. Palliative Care
   2. Intravenous Access difficult or impractical
   3. Patient unable to take fluids orally
      1. Nausea or Vomiting
      2. Intestinal Obstruction
      3. Cerebrovascular Accident
4. Contraindications
   1. Not indicated in pediatric patients
   2. Clotting disorder
   3. Pulmonary edema
   4. Large volume fluids required
      1. Severe dehydration or shock
      2. Severe electrolyte disturbance
5. Technique
   1. See Hypodermoclysis Technique
6. Adverse Effects
   1. Mild subcutaneous edema (resolves with local massage)
   2. Local catheter site erythema, swelling or obstruction
   3. Infusion site discomfort (less common than with IV)
      1. Associated with deep needle insertion into muscle
      2. Associated with too rapid infusion rate
   4. Cellulitis at infusion site rarely occurs
7. Efficacy
   1. Similar to intravenous fluid in moderate dehydration
8. Advantages over intravenous therapy
   1. Less discomfort (and agitation in cognitively impaired)
   2. Fewer complications than with IV fluid
      1. Less likely to cause pulmonary edema
      2. No thrombophlebitis risk
      3. No associated Sepsis risk
      4. No clot formation when clamped
   3. Family members can administer at home
   4. Lower cost
9. Disadvantages compared with intravenous therapy
   1. Infusion rate is slow: 1 ml/minute on average
      1. May be increased with use of hyaluronidase
   2. Local edema at site (see adverse effects)
10. References
    1. Fainsinger (1994) J Pain Symptom Manage 9:298-302
    2. Farrand (1996) Br J Hosp Med 55:690-2
    3. Ferry (1999) J Am Geriatr Soc 47:93-5
    4. Hussain (1996) J Am Geriatr Soc 44:969-73
    5. Mansfield (1998) Nurs Stand 13:56-62
    6. Sasson (2001) Am Fam Physician 64(9):1575-8
    7. Slesak (2003) J Am Geriatr Soc 51:155-60